Tag Archives: supplements

The other day I received a question on what supplements Autumn takes. I thought it might be helpful to list out everything – just so that if you have come to this blog as a “newbie” you can get a rough idea on what supplements might need to be taken. However, it is EXTREMELY important for you to be working with your dietician as to what YOU will need for yourself, or your child. Again, EVERYONE is different.

When we first started the diet, Autumn could not swallow pills – to this day, she still has a hard time. We tried practicing early on, but it seemed to cause more stress than progress. She can take very small capsules, but found it very difficult to swallow anything large. So what was our solution? Being faithful to what she could do. I could not do what she does, and I would prefer her to do it my way 😉 but as long as she gets the vitamins down – all is well!

Here is a picture of all her vitamins: It looks overwhelming, but…

It is split up three ways during the day:

First AM:

Autumn always has at least 1 Tablespoon of Coconut oil – it is either part of her breakfast food– as in the Apples and P-nut butter recipe – or straight off the spoon. And I take mine right along with her!

We just put some in a metal cup and melt it on the stove:

After breakfast:

1 – Levo-Carnitine* – crushed on a spoon and taken with a bit of water.

½ – kphos (Prescription) tablet dissolved in water.

1 – 5g Iron

1 – A and D capsules (When we had her check-up lab work, we found her to be low in these.)

This is what the Carnitine (a before and after of the pill crushed up) and K-phos look like:

Late Afternoon:

Every afternoon around 4:00 Autumn has her “Vitamin Snack:”

We measure out about 5 grams of butter, and add:

½ tablet daily vitamin – crushed up.

2 – Bone Basic capsules are opened up and added into the butter.

¼ of a Kelp capsule open up and added in to butter.

All of this is stirred up and spread on a “Keto Cheese Cracker” (See page 118 in the Keto Cookbook or check out my post: “You can’t eat Just one.”

She then somehow puts that all in her mouth and drinks water at the same time to swallow it down – again, not my way, but it works – and she does not complain!

She also has 1 more Levo-Carnitne, and another ½ kphos in water.

She has this, along with Kale chips, cheese and pecans – and sometimes her “keto soda” or “keto-tea”- and she has had this everyday since May of 2012! This works for her – she enjoys it (well maybe not the butter vitamin cracker 😉 ) – it may not work for you, or your child might like some variety. The point is, it is doable – you can work something out.

Evening:

In the evening before going to bed, she takes one last levo-carnitine (crushed up with a little water on the spoon). If I feel she might be getting sick – or if there is sickness in the house, I also have her take some of the Vitamin C powder – which also has magnesium and that can help with constipation.

There have been times when Autumn’s TC02 levels were too low and her Anion Gap too high so our Dieticain advised that she drink approximately 1/2 tsp baking soda in water and have her drink it twice a day to bring the acidity down.

*A note on Carnitine: When we first started Autumn on the diet we did not know if we should use carnitine or not. On her first set of follow-up labs, her carnitine was low so we started her on an over-the counter brand. Initially that helped, but then her levels became low again. Several months later on another follow-up lab test we found her to be low again- despite quite a high dose of the over-the-counter, so we started her on the prescription strength, levo-carnitine. The result has been an improved carnitine ratio which increased her ketone levels. This allowed us to lower her ratio and thus were able to add more fruits and veggies. The dose she is on is actually lower than what is typically prescribed for her weight, but with her ketone levels raising quite high, it was a good dose for her. Once again, I have found the blood ketone monitor to be an indispensable tool. Without having the monitor, we would not have seen the levels rise. Here is an explanation of carnitine from our dietitian:

It is quite common for carnitine levels to go low on the diet. Carnitine is like a shuttle bus that carries fat into the mitochondria, where it is burned for energy. A normal diet would be analogous to having a shuttle bus show up when there are 5 people at the bus stop. Everyone can get on the bus. A ketogenic diet is analogous to having a crowd waiting at the bus stop, and not everyone can get on the bus unless more shuttle buses are added.

Our bodies can make carnitine, but many children can’t make enough carnitine to meet the added demands of the ketogenic diet. A carnitine deficiency can cause ketones to go low, weight loss can occur because not all of the fat is utilized and the body doesn’t get enough calories, and children can have more fatigue and less endurance. In more severe cases, carnitine deficiency can cause metabolic acidosis and cardiomyopathy (heart problems). So it is important to make sure children are routinely tested while on the ketogenic diet, and to supplement with carnitine if a deficiency develops.

Some people have asked what labs we do:

Suggested Laboratory Tests For Ketogenic Diet

Once again, this is posted as a general guideline for testing. Please be working with your doctor/dietitian to be covering your needs!

Baseline lab draw, then after 3 months and then every 6 months:

Comprehensive Metabolic panelLipid profileCBC with DifferentialBetahydroxbutarate (if you are testing with your own monitor, this may not be necessary)Carnitine, Free, and TotalUric AcidVitamins A,D,EZincSeleniumIf on meds, Anticonvulsant medication levelsCheck with Dietitian/Dr. on: Acylcarnitine Profile, Quantitative

Make sure to give a Vitamin D supplement, especially if you live in the northern part of the country.

Autumn’s neutrophil levels and platelets have tended to run on the low side on the diet. Some research literature suggests that that is a side effect of the diet. We were quite concerned so we did take her to see a pediatric hematologist, and although he did not know why, he felt the diet was probably causing the lower levels. Her over health has been excellent so he was not concerned.

We always kept an eye on the TC02 and Anion gap as that was an indeiation of acidity in the body. When those numbers were off, we made sure Autumn was drinking baking soda daily to bring the acidity down.

The faithfulness of taking these vitamins daily have lead to some of the best lab work since she has been on the diet – and it has been almost 22 months!

As with all things in life, it is the daily discipline in all the small stuff – taking the vitamins, exercise, daily watching what you eat, how much money you are spending, brushing your teeth, watching your tones and attitudes – daily – that often pay off big dividends over time. Yes, it can be boring, wearying and tedious, but….

“Do not grow weary in well-doing, for in due season you shall reap, if you faint not.” (Galations 6:9)

“He who is faithful in the little things, will be faithful in much.” (Luke 16:10)